Abstract

MedWire News: A larger proportion of Type 2 diabetes patients can achieve a glycated hemoglobin (HbA1c) target of less than 7% if they are treated with biphasic or prandial rather than basal insulin, report researchers.

There was also evidence to suggest that basal bolus insulin could be more effective than biphasic insulin for achieving this target, with a similar side-effect profile.

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Dario Giugliano, from the Second University of Naples in Italy, and colleagues carried out a meta-analysis of 16 randomized controlled trials comparing treatment with insulin analogs in 7759 Type 2 diabetes patients aged 58.2 years on average.

To be included, studies had to last for at least 12 weeks, had to report how many patients reached a HbA1c target of less than 7%, and had to have over 30 patients in each treatment arm.

The results of the pooled analysis showed that patients were a significant 1.88- and 2.07-fold more likely to achieve a HbA1c goal of less than 7% if they were treated with biphasic or prandial insulin, respectively, compared with basal insulin.

However, treatment with biphasic insulin resulted in a significant 0.34 more events per patient per 30 days, and a borderline significant 1.0 kg greater weight gain than treatment with basal insulin. A similar, but less significant increase in risk for hypoglycemia and weight gain was observed for prandial versus basal insulin.

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A small number of studies compared biphasic with basal bolus insulin. The pooled analysis of these studies showed that patients treated with the latter analog were a significant 1.75-fold more likely to achieve the HbA1c goal than those treated with biphasic insulin, with a similar incidence of hypoglycemia and degree of weight gain in both groups.

"Basal insulin is associated with a lower proportion of diabetic patients at target compared with prandial or biphasic insulin, but with less hypoglycemia and weight gain compared with biphasic insulin," summarize the researchers.

"More studies are needed to understand better the effect of insulin analogs on long-term diabetes complications," they conclude in the journal Diabetes Care.